Healthcare Provider Details

I. General information

NPI: 1720058365
Provider Name (Legal Business Name): LAURA JO BARKER PA-C, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA JO PRUNTY

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 11/27/2023
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1287 BURNS WAY
KALISPELL MT
59901-3109
US

IV. Provider business mailing address

1287 BURNS WAY
KALISPELL MT
59901-3109
US

V. Phone/Fax

Practice location:
  • Phone: 406-752-8120
  • Fax: 406-752-8134
Mailing address:
  • Phone: 406-752-8120
  • Fax: 406-752-8134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number34568
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: